With ever increasing drug costs, providers are prescribing generic alternatives to minimize out of pocket costs for patients and to help contain costs for the health system. As a pharmacist, I encourage generic utilization when appropriate. However, not all generic formulations are the most inexpensive therapeutic options – such as commonly prescribed generic PPI omeprazole-bicarbonate.
Given the similar safety and efficacy profile of omeprazole and omeprazole-bicarbonate, it’s shocking to see the significant price difference between these two generic prescription medications (see chart below). Additionally, patients who have occasional heartburn (less than 2 times weekly) or uncomplicated gastroesophageal reflux disease (GERD), may benefit from a short course of over the counter PPIs prior to being prescribed long-term treatment. Both omeprazole (Prilosec OTC) and omeprazole-bicarbonate (Zegerid OTC) are available without a prescription and average only $12 for a 2 week treatment course.
To further highlight the impact of the price differential of these two products, compare costs for patients on the KentuckyOne Health/CHI Medical during the 2nd quarter for our CHI Medical Plan:
• 24 prescriptions of omeprazole-bicarbonate cost the organization $81,000
• 915 prescriptions of omeprazole equated to only $14,000.
Omeprazole is unstable in the acidic environment of the stomach and conventional oral formulations are available as delayed-release products with enteric coatings. To contrast, omeprazole-bicarbonate is a dual ingredient formulation containing omeprazole along with a sodium bicarbonate buffer. Combining uncoated omeprazole powder with sodium bicarbonate allows for rapid delivery to the site of drug absorption, while decreasing gastric acid degradation following administration. Although omeprazole-bicarbonate does have a slightly faster anti-secretory effect which may provide quicker relief from heartburn symptoms, when compared to traditional delayed-release omeprazole formulations, both products still have a very comparable onset of action of 1 hour along with a duration of action lasting up to 72 hours. Also it’s important to keep in mind that due to the addition of sodium bicarbonate, patients receive a sodium load equivalent to 300mg of sodium in each capsule; an alternative PPI such as omeprazole may be more appropriate treatment for patients on a sodium-restricted diet.